Associations between adult relationships and Problematic Social Media Use across adolescent ages in Italy: Findings from the international HBSC 2021/2022 survey

OBJECTIVE: Problematic Social Media Use (PSMU) is increasingly recognised as a public health concern in adolescence. This study examined age- and sex-specific associations between health, perceived social support, and PSMU among adolescents in Tuscany, Italy STUDY DESIGN: Cross-sectional, school-based survey. METHODS: Data from 3210 adolescents aged 11-17 years were drawn from the Italian 2021/2022 HBSC survey. PSMU was assessed using the Social Media Disorder Scale (≥6/9 criteria). Sex-stratified logistic regression models adjusted for age group and family affluence examined associations with health and social support indicators. RESULTS: Overall PSMU prevalence was 12.1%, higher in girls than boys (13.6% vs. 10.5%). Among boys, prevalence declined with age; among girls, it peaked at 15 years (16.8%). In both sexes, PSMU was inversely associated with good self-rated health (boys: OR = 0.44; girls: OR = 0.41), high wellbeing (boys: OR = 0.57; girls: OR = 0.59), and family support (boys: OR = 0.37; girls: OR = 0.63), and positively associated with weekly sleep difficulties (boys: OR = 2.22; girls: OR = 1.94) and multiple psychosomatic symptoms (boys: OR = 1.84; girls: OR = 2.90). Parental communication was inversely associated with PSMU among girls only, while peer support was inversely associated among boys. CONCLUSIONS: PSMU co-occurred with poorer health and lower perceived social support. Family support and parent-adolescent communication were associated with lower odds of PSMU, but the cross-sectional design precludes causal interpretation. Longitudinal and intervention studies are needed to clarify directionality.